Polycystic Ovarian Syndrome, or PCOS, is a disorder of the female endocrine system, the system of glands which produce hormones to regulate the body’s functions. In normal ovaries, eggs are developed and released by the follicles. The empty follicles then dissolve and are reabsorbed into the ovary.
Between 5% and 10% of women between 15 and 44, or during the years you can have children, have PCOS. Most women find out they have PCOS in their 20s and 30s when they have problems getting pregnant and see their health care provider. Female adolescents and women with PCOS may be at higher risk for depression and anxiety. Women with PCOS, especially who are overweight, may experience pregnancy complications, including gestational diabetes, preterm delivery, or pre-eclampsia. But PCOS can happen at any age after puberty.
Women of all races and ethnicities are at risk of PCOS. You may be a higher risk of PCOS if you are overweight or if you have a female relative with PCOS. Overweight women with PCOS can also develop a condition called obstructive sleep apnea when breathing stops repeatedly during sleep. This condition can worsen the insulin resistance and cardiovascular problems of women with PCOS.
Hormones and Polycystic Ovary Syndrome
Polycystic ovary syndrome causes high levels of androgens to be produced. This prevents the eggs to mature. The immature follicles cannot dissolve like normal and instead develop into small fluid-filled cysts, often referred to as “sac of pearls”. The high levels of androgens can also cause multiple symptoms.
Diagnosis of PCOS
There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor will review your medical history and do a physical exam and different tests:
- Physical exam. Your blood pressure, body mass index (BMI), and waist size will be checked. They will also look at your skin for excess hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for thinning hair or signs of other health conditions (such as an enlarged thyroid gland).
- Pelvic exam. This may be performed for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
- Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).
- Blood tests. This is to check your androgen hormone levels, sometimes called “male hormones.” Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. You may also be tested for cholesterol levels and diabetes.
Symptoms of PCOS
Women with PCOS symptoms typically experience:
- Unpredictable and or irregular periods – These can be absent or infrequent menstrual periods or periods that occur too frequently
- Several small ovarian cysts
- Severe acne or acne that doesn’t respond to treatment
- Oily skin
- Acanthosis nigricans – abnormal patches of skin that appear dark and velvety
- Skin tags – small excess flaps of skin in the armpits or neck area
- Hirsutism – abnormal hair growth on the chest, face, upper thighs, and abdomen
- Male-pattern hair loss or baldness
- Severe weight gain – affects about 8 out of 10 women with PCOS
- Infertility
If you’re experiencing these symptoms, please make an appointment with your OB-GYN. Keep notes of your symptoms and be sure to ask any questions. Your OB-GYN will make a diagnosis based on your symptoms, hormone levels, and/or the findings on ultrasound.
Health Risks of Polycystic Ovary Syndrome
The exact cause of PCOS is unknown. However, we do know it is related to insulin resistance and increased levels of androgens (male hormones) in the bloodstream. Also, they often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
Women with PCOS often have insulin resistance. Insulin resistance involves the body’s inability to lower blood sugar levels correctly.
These factors contribute to a woman’s risk of serious illness and complications relating to PCOS. Research shows that women with PCOS have an increased risk of developing:
- Type 2 diabetes mellitus
- Hypertension (high blood pressure)
- Cholesterol problems
- Cardiovascular disease (heart disease)
- Metabolic syndrome
- Endometrial hyperplasia – a disease in which the endometrium grows too thick, which raises the risk of endometrial cancer.
Treatment of Polycystic Ovary Syndrome
If you are diagnosed with PCOS, your OB-GYN will recommend a course of treatment based on your symptoms, your medical history, and your desire to become pregnant in the future. If you do wish to become pregnant, it’s important that your course of treatment of PCOS restores your ability to ovulate. Some treatments may include:
Combined hormonal birth control pills. This is an oral contraceptive treatment that delivers both estrogen and progestin to the body to regulate the menstrual cycle and reduce androgen levels. It can reduce menstrual irregularities and decrease unwanted body hair and acne. This treatment plan can work in the long-term for women who no longer wish to become pregnant.
Weight loss. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a minor weight loss of 10 or 15 pounds can help regulate menstrual periods and insulin levels in women with PCOS. Some women even report an improvement in acne and unwanted hair growth.
Insulin-sensitizing drugs. These drugs are normally used to treat patients with diabetes, but they can help women with PCOS by facilitating the body’s response to insulin. They can also jumpstart ovulation by reducing levels of androgens. This helps put the menstrual cycle back on track.
Removing hair. Try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures such as laser hair removal or electrolysis must be done by a doctor and your insurance may not provide coverage.
Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.
If you believe you are experiencing symptoms of, or suffering from Polycystic Ovarian Syndrome, or have questions about it, please see your doctor.
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Dr. Thaïs Aliabadi
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.